Health Workforce Research e-Library

In this video Ed Salsberg, MPA, FAAN, provides an overview of the exit survey process.

In this video Komal Kochhar, MBBS, MHA, discusses the resident exit survey at the Indiana State University of Medicine.

This infographic describes the satisfaction of clinical providers, organizational administrators, and patients with the dental therapy workforce at Apple Tree Dental in Minnesota, the first US state to authorize dental therapy practice statewide.

Postgraduate dental (PGD) primary care training has grown significantly. This study examines the individual, educational, community, and policy factors that predict practice patterns of PGD-trained dentists.

This study examines the individual, educational, and policy factors that predict dentists pursuing postgraduate dental (PGD) training.

This report reviews the use of teledentistry following the COVID-19 pandemic in 4 states—California, Maine, Pennsylvania, and Wisconsin—and the supports needed to enhance dental care in a post-COVID-19 world.

Dental therapy is a workforce model that introduces mid-level practitioners—dental therapists—with both preventive and restorative skills. The introduction of dental therapists appears to improve access to and equity in dental service delivery in the US. The Oral Health Workforce Research Center conducted a study that evaluated the satisfaction of clinical providers, organizational administrators, and patients with the dental therapy workforce at Apple Tree Dental in Minnesota, the first US state to authorize dental therapy practice statewide. This report describes the results from 2 surveys on the dental therapy workforce at Apple Tree Dental’s centers and programs: 1) clinician and administration satisfaction and 2) patient satisfaction with their clinical providers, making comparisons across provider type.

Currently, 13 states and tribal nations have expanded their dental workforce by adopting use of dental therapists. To date, there has been no evaluation of the influence of this policy on dental care use. This study assesses changes in dental care use in Minnesota after the implementation of the policy to authorize dental therapists in 2009.

Little is known about the scope and role of discriminatory experiences in dentistry. The purpose of this study is to document the experiences that American Indian/Alaska Native (AI/AN), Black, and Hispanic dentists have had with discrimination.

There is a lack of diversity in the dental workforce. Efforts to enhance underrepresented minority (URM) recruitment and retention within dental school exist, but little effort has been made to track URM providers through education and practice. This study assesses the status of workforce diversity in the dental specialties and the predictors of URM dentist specialization.

The aim of this study was to examine changing trends in post-baccalaureate programs available to pre-dental students and to assess the role these programs play in improving oral health workforce diversity.

Studies estimate that approximately one-third of all opioid prescriptions (Rxs) from dentists are associated with nonsurgical dental procedures, which suggests unwarranted opioid use. The authors conducted a retrospective longitudinal cohort study of adult Medicaid beneficiaries using administrative claims data from New York (NY) and Oregon (OR) (2014-2016) to examine opioid Rxs associated with nonsurgical dental visits.

This study aimed to understand the unique experiences of low-wage or underpaid essential, frontline workers during COVID-19 across hospital settings to better identify strategies to support them during and beyond the pandemic.

This study interviewed primary care nurse practitioners (NP) and physician assistants (PA) to identify which components of NP and PA onboarding programs are successful and why.

Systematic and equitable integration of foreign-educates nurses (FENs) into the long-term care (LTC) workforce requires deeper understanding of their contributions and impact on care. Because research about these phenomena is limited, we synthesized literature about factors influencing nurse migration to the United States and how FENs impacted LTC.

Newly graduated nurse practitioners (NPs) and physician assistants (PAs) face challenges in adapting to their first jobs. Because of this, some organizations are instituting formal NP and PA onboarding programs, which have been associated with increased engagement of NPs/PAs, decreased turnover, and higher clinical productivity. This policy brief examines which components of NP and PA onboarding programs are successful and why, highlighting 6 structural components and 2 psychosocial components that employers and managers could incorporate into their onboarding programs. 

There have been no studies to date of moral distress during the COVID-19 pandemic in national samples of U.S. health workers. The purpose of this study was to determine, in a national sample of internal medicine physicians (internists) in the U.S.: 1) the intensity of moral distress, 2) the predictors of moral distress, 3) the outcomes of moral distress.

This study sought to understand the experiences of frontline essential workers to better support them and prevent burnout.

News photos and stories of health professionals in intensive care units overflowing with ill patients have been among the most iconic images of the COVID-19 pandemic. These clinicians have shown physical and emotional exhaustion, and also claim to be morally distressed by witnessing and participating in patients' care and deaths in sheer numbers under circumstances that feel morally wrong. Moral distress among healthcare professionals is a concept several decades old but still evolving. This article explores the causes and levels of moral distress experienced by clinicians caring for low-income patients of safety net practices in the US during the COVID-19 pandemic.

This report describes workplace violence in healthcare settings.

Despite evidence supporting the integration of pharmacists in team-based primary care, little evidence exists on the colocation of pharmacists with primary care physicians (PCPs) in the United States and even less information exists on the factors associated with these models in primary care. Increasing the colocation of pharmacists and PCPs gives practitioners greater ability to meet the patient’s healthcare needs at the point of care. However, integrated health care delivery models may be less present in rural and underserved areas and in states with restricted pharmacist scope of practice, potentially contributing to unequal access to this model of care. This brief investigates the prevalence of colocation of pharmacists with PCPs and examines the factors associated with colocation, including geographic location.

Perceived organizational support (POS) may promote healthcare worker mental health, but organizational factors that foster POS during the COVID-19 pandemic are unknown. The goals of this study were to identify actions and policies regarding COVID-19 that healthcare organizations can implement to promote POS and to evaluate the impact of POS on physicians’ mental health, burnout, and intention to leave patient care.

The health care sector lost millions of workers during the COVID-19 pandemic and job recovery has been slow, particularly in long-term care. This study identified which health care workers were at highest risk of exiting the health care workforce during the COVID-19 pandemic.

To meet growing demand, address social determinants of health, and improve health equity, a larger and more diverse registered nurse (RN) workforce is needed in the US. To do so, it is important to understand current pathways and barriers to becoming an RN. This article published in Policy, Politics, & Nursing Practice examines prior health care employment and financial assistance factors associated with completion of pre-licensure RN education programs by initial entry degree (associate degree or bachelor of science in nursing) and across racial and ethnic groups.

The National EMS Scope of Practice Model is a blueprint for states to develop scopes of practice for emergency medical services (EMS) practitioners. It is intended to reduce inconsistencies between states and provide a basis from which national standards of care and performance for each level of EMS practitioner can be developed. Such standards can help reduce health disparities and improve patient outcomes. This report examines the extent to which EMS professionals perform skills that correspond to the national Model credential levels. Variations in adherence to Model guidelines between agencies serving rural versus urban populations and agencies with volunteer versus paid staffing models is also explored.

Medical assistants (MAs) are among the fastest-growing occupations in the United States, yet health care employers report high turnover rates and difficulty filling MA positions. Employers are increasingly using apprenticeship to meet emerging workforce needs. This qualitative study examined the perspectives of 14 employers using registered MA apprenticeships in 8 states.

This presentation focuses on health workforce apprenticeships.

The focus of this rapid response brief is on the birth doula workforce, which is the dominant type of doula discussed in the literature (other types of doulas not covered in this brief serve their clients through abortion or infant loss, death, and adoption among many others)

Birth doulas support pregnant people during the perinatal period. Evidence of doulas' positive impacts on pregnancy and birth outcomes, particularly among underserved populations, supports expanding access. However, health workforce-related barriers challenge the development of robust doula services in the United States. This study examined the various approaches organizations have taken to train, recruit, and employ doulas as well as their perspectives on what system-level changes are needed to redress health inequities in underserved communities and expand access to birth doula services.

Research has shown evidence of doulas’ positive impacts on maternal health outcomes, particularly among underserved populations. Such research supports expanding access to doula services. However, health workforce-related barriers challenge the development of robust doula services in the US. This article published in the Journal of Perinatal Education investigates organizations’ barriers regarding training, recruitment, and employment of doulas.

The objective of this study was to examine navigators' labor at a granular level to better understand and highlight the equity work they do, the training and skills required for this work, and the Navigator Program–based challenges they face.

Community-based birth doulas support pregnant women, transgender men, and gender non-binary individuals during the perinatal period and provide essential services and expertise that address health inequities, often taking on additional roles to fill systemic gaps in perinatal care in the United States (US). Despite the benefits that community-based birth doulas provide, there is little research exploring the work-related conditions and stressors community-based doulas experience. To address this gap, we examined the work experiences, related stressors, and stress management strategies of individual community-based birth doulas.

This policy brief describes workforce challenges faced by rural health care delivery systems and how pre-pandemic financial instability in rural health care facilities may have contributed to the challenges experienced by the rural health workforce during the pandemic. Available federal pandemic funding to address rural health workforce needs is also discussed, as well as the long-term needs of the rural health workforce and delivery system.

Health care workers play crucial roles in interventions and policies that promote health equity by providing culturally sensitive services, partnering with communities to promote population health, and addressing unconscious racial and ethnic biases in health care delivery. Despite their significance for eliminating health disparities experienced by historically marginalized communities, the roles that the health workforce plays within these interventions are not systemically monitored. In this study, we sought to understand how health care workers are expected to address issues of health equity.

This presentation focuses on health workforce development and literacy in health equity.

In the initial months of the COVID-19 pandemic, health care decision-makers in North Carolina needed information about the available health workforce in order to conduct workforce surge planning and to anticipate concerns about professional or geographic workforce shortages. This article describes how data was used in the early stages of the COVID-19 pandemic in North Carolina to support decisions about the deployment, surge, and maintenance of necessary health care staff.

This column will evaluate whether one training program supporting master's of social work specialized training in integrated health care settings is aligned with state Medicaid expansion.

This report provides data to substantiate the recommendations made in a companion report, “Supporting National Health Service Corps and Other Safety Net Clinicians Facing Personal and Professional Challenges due to COVID-19: Recommendations to HRSA,” dated February 5, 2021. This report’s data are from the Survey of the Pandemic Experiences and Effects on Clinicians in Safety Net Practices in 20 States, which sought input from 3,924 National Health Service Corps clinicians working in safety net practices in 20 states.

This report offers recommendations to the Health Resources and Services Administration for ways that HRSA can support clinicians working in safety net settings during the COVID-19 pandemic. HRSA’s Bureau of Health Workforce sponsors the National Health Service Corps (NHSC) and its Bureau of Primary Health Care sponsors the clinics and practices where most NHSC clinicians work.

This exploratory pilot study aimed to (a) determine the feasibility of using EHR documentation to identify behavioral health and social care components of integrated care, using social work as a use case, and (b) develop a lexicon to inform future research using natural language processing.

North Carolina, as a state with a significant Black population and fast-growing Hispanic population, is greatly reflective of national demographic changes. Due to these demographic changes, the US is currently facing challenges to recruit and retain a general surgery workforce that mirrors the population. This article examines the slow and gradual diversification of the surgical workforce in North Carolina.

Clinical setting and geographic location effects access to surgical services and potentially the quality of care. Through examining the distribution of general surgeons across billing entities and within hospital referral regions (HRRs), a trend towards practice in larger medical organizations from traditional hospital settings is emerging. This article reviews how population changes over time in different geographical regions have impacted the market structure and availability of general surgeons in the United States.

Preventive medicine physicians work at the intersection of clinical medicine and public health. Previous reports on the state of the preventive medicine workforce revealed an ongoing decline in preventive medicine physicians and residents, but there have been few updates in recent years. This article describes trends in both the number of board-certified preventive medicine physicians and those physicians who self-designate preventive medicine as a primary or secondary specialty, as well as the age, gender distribution, and geographic distribution of this workforce.

Little is known about the job satisfaction of licensed clinical social workers (LCSWs) participating in the National Health Service Corps (NHSC) federal Loan Repayment Program (LRP). Employee satisfaction in organizations is important for organizational well-being and to decrease turnover. This article examines the work and practice satisfaction of LCSWs participating in the NHSC LRP. Findings have the potential to inform the NHSC's strategies in managing and retaining LCSWs.

The COVID-19 pandemic created a rapid change in care environments without sufficient training or support for most. For the healthcare system to be able to properly respond to the pandemic, as well as future public health challenges, there is a need for greater access to guidelines, training tools, and other support for patient care. This research brief describes a series of playbooks, developed by the North Carolina Health Workforce Research Center and a team from the North Carolina Area Health Education Centers (AHEC) program, that provide health care systems, states, the federal government, and other stakeholders with updated, state-of-the-art resources to promote local flexibility to respond to workforce challenges and shortages during the pandemic and beyond.

We conducted a national survey in 2020 of internists who are members of an online panel maintained by the American College of Physicians (ACP), the largest medical specialty organization in the United States. The panel, representative of the ACP U.S. post-graduate membership, consists of ACP members who consider participating in periodic online surveys for modest remuneration.

As the U.S. population ages and the demand for long-term care increases, an insufficient number of licensed practical nurses (LPNs) is expected in the nursing workforce. Understanding the characteristics of LPN participation in the workforce is essential to address this challenge. Drawing on the theory of boundaryless careers, the authors examined longitudinal employment data from LPNs in North Carolina and described patterns in LPN licensure and career transitions. Two career patterns were identified: (a) the continuous career, in which LPNs were licensed in 75% or more of the years they were eligible to be licensed and (b) the intermittent career, in which lapses in licensure occurred.

Despite recent research on wellbeing in medicine, much of it fails to address the broader structural factors that contribute to physician satisfaction and wellbeing. To address that gap, researchers used a novel socio-ecological framework adapted from a National Academies of Science, Engineering, and Medicine’s “systems model,” and conducted interviews with 65 attendings, residents, medical students, and clinic staff or administrators. This policy brief examines the interplay between individual, institutional, professional, and systems-level factors in shaping physicians’ responses to their work conditions across the career span, from medical students to attending physicians, and offers suggestions for policy interventions at various structural levels.

The federal government uses multiple definitions for identifying rural communities based on various geographies and different elements of rurality. The objectives of this study were to: (1) assess the degree to which rural definitions identify the same areas as rural, and (2) assess rural-urban disparities identified by each definition across socioeconomic, demographic, and health access and outcome measures.

To identify the strategies and interventions U.S. health systems implemented to reduce burnout and increase employee well-being during the first year of the COVID-19 pandemic.